Abstract
Twenty-five years ago, the nightmares typically experienced in the course of PTSD were first referred to as a hallmark of the disorder. PTSD-related nightmares share some characteristics with idiopathic nightmares, but the often trauma-replicating nature of disturbing dreams experienced by individuals with PTSD continues to be a key clinical manifestation of PTSD. A number of validated measures have been developed to measure the frequency, intensity, content, and clinical significance of nightmares. The neurobiologic mechanisms underlying the development and persistence of replicative nightmares in PTSD are still being investigated. Two sets of psychological theories of dreaming, threat simulation theory and theories related to emotional adaptation, provide some context for understanding nightmares. Clinically, nightmares in PTSD are associated with significant distress and morbidity. In addition to psychological interventions that may reduce the frequency and intensity of nightmares, numerous medications have been evaluated for the treatment of nightmares with prazosin standing out as the most promising of these pharmacotherapies.
Abbreviations
- CAPS:
-
Clinician-administered PTSD scale
- CBT:
-
Cognitive-behavioral therapy
- CBT-I:
-
Cognitive-behavioral therapy for insomnia
- DSM 5:
-
Diagnostic and statistical manual of mental disorders 5th edition
- IRT:
-
Imagery rehearsal therapy
- NM:
-
Nightmare
- PTSD:
-
Post-traumatic stress disorder
- RCT:
-
Randomized controlled trial
References
American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-5. Washington, DC: American Psychiatric Association; 2013.
Aurora RN, Zak RS, Auerbach SH, Casey KR, Chowdhuri S, Karippot A, . . . Bista SR. Best practice guide for the treatment of nightmare disorder in adults. J Clin Sleep Med. 2010;6(4):389–401.
Belicki K. The relationship of nightmare frequency to nightmare suffering with implications for treatment and research. Dreaming. 1992;2(3):143.
Belleville G, Guay S, Marchand A. Persistence of sleep disturbances following cognitive-behavior therapy for posttraumatic stress disorder. J Psychosom Res. 2011;70(4):318–27.
Bódizs R, Simor P, Csóka S, Bérdi M, Kopp MS. Dreaming and health promotion: a theoretical proposal and some epidemiological establishments. Eur J Ment Health. 2008;3(1):35–62.
Breslau N, Roth T, Burduvali E, Kapke A, Schultz L, Roehrs T. Sleep in lifetime posttraumatic stress disorder: a community-based polysomnographic study. Arch Gen Psychiatry. 2004;61(5):508–16.
Brown RJ, Donderi DC. Dream content and self-reported well-being among recurrent dreamers, past-recurrent dreamers, and nonrecurrent dreamers. J Pers Soc Psychol. 1986;50(3):612–23. doi:10.1037/0022-3514.50.3.612.
Byrd PM, Davis JL, Schneider CN, Cantrell C, Tracy V, Fernandez S. Characteristics of chronic nightmare in a clinical, trauma-exposed sample. Paper presented at the Poster presented at the International Society of Traumatic Stress Studies. 2006.
Cartwright RD. Dreams and adaptation to divorce trauma and dreams. Cambridge, MA: Harvard University Press; 1996. p. 179–85.
Christo G, Franey C. Addicts drug-related dreams: their frequency and relationship to 6-month outcomes. Subst Use Misuse. 1996;31(1):1–15.
Cowdin N, Kobayashi I, Mellman TA. Theta frequency activity during rapid eye movement (REM) sleep is greater in people with resilience versus PTSD. Exp Brain Res. 2014;232(5):1479–85.
Davis JL, Wright DC, Borntrager CF. Trauma related nightmare survey. Tulsa: University of Tulsa; 2001. Unpublished measure.
Davis JL, Byrd P, Rhudy JL, Wright DC. Characteristics of chronic nightmares in a trauma-exposed treatment-seeking sample. Dreaming. 2007;17(4):187.
Dierks MR, Jordan JK, Sheehan AH. Prazosin treatment of nightmares related to posttraumatic stress disorder. Ann Pharmacother. 2007;41(6):1013–7.
Domhoff GW. The repetition of dreams and dream elements: a possible clue to a function of dreams. In: Moffitt A, Kramer M, Hoffmann R, editors. The functions of dreaming. SUNY series in dream studies. Albany: State University of New York Press; 1993. p. 293–320.
Donovan BS, Padin-Rivera E, Chapman H, Strauss M, Murray M. Development of the nightmare intervention and treatment evaluation (NITE) scale. J Trauma Pract. 2005;3(3):47–68.
Esposito K, Benitez A, Barza L, Mellman T. Evaluation of dream content in combat-related PTSD. J Trauma Stress. 1999;12(4):681–7. doi:10.1023/a:1024725319777.
Gehrman PR, Harb GC, Cook JM, Barilla H, Ross RJ . Sleep diaries of Vietnam War veterans with chronic PTSD: the relationships among insomnia symptoms, psychosocial stress, and nightmares. Behav Sleep Med. 2015;13(3),255–264.
Germain A. Sleep disturbances as the hallmark of PTSD: where are we now? Am J Psychiatr. 2013;170(4):372–82.
Germain A, Nielsen TA. Sleep pathophysiology in posttraumatic stress disorder and idiopathic nightmare sufferers. Biol Psychiatry. 2003;54(10):1092–8.
Hackmann A, Ehlers A, Speckens A, Clark DM. Characteristics and content of intrusive memories in PTSD and their changes with treatment. J Trauma Stress. 2004;17(3):231–40. doi:10.1023/B:JOTS.0000029266.88369.fd.
Hall C, Van de Castle R. The content analysis of dreams. New York: Appleton; 1966.
Harb GC, Thompson R, Ross RJ, Cook JM. Combat-related PTSD nightmares and imagery rehearsal: nightmare characteristics and relation to treatment outcome. J Trauma Stress. 2012;25(5):511–8. doi:10.1002/jts.21748.
Harvey AG, Jones C, Schmidt DA. Sleep and posttraumatic stress disorder: a review. Clin Psychol Rev. 2003;23(3):377–407.
Hellawell SJ, Brewin CR. A comparison of flashbacks and ordinary autobiographical memories of trauma: content and language. Behav Res Ther. 2004;42(1):1–12. doi:10.1016/S0005-7967(03)00088-3.
Hermes E, Harpaz-Rotem I, Rosenheck R. Diffusion of prazosin treatment for PTSD. Am J Psychiatr. 2014;171(1):117.
Huntley ED, Hall Brown TS, Kobayashi I, Mellman TA. Validation of the fear of sleep inventory (FOSI) in an urban young adult African American sample. J Trauma Stress. 2014;27(1):103–7.
Köthe M, Pietrowsky R. Behavioral effects of nightmares and their correlations to personality patterns. Dreaming. 2001;11(1):43.
Krakow B. Nightmare complaints in treatment-seeking patients in clinical sleep medicine settings: diagnostic and treatment implications. Sleep. 2006;29(10):1313–9.
Krakow B, Tandberg D, Barey M, Scriggins L. Nightmares and sleep disturbance in sexually assaulted women. Dreaming. 1995;5(3):199.
Krakow B, Melendrez DC, Johnston LG, Clark JO, Santana EM, Warner TD, . . . Lee SA. Sleep dynamic therapy for Cerro Grande Fire evacuees with posttraumatic stress symptoms: a preliminary report. J Clin Psychiatry. 2002;63(8):673–84.
Krakow B, Schrader R, Tandberg D, Hollifield M, Koss MP, Yau CL, Cheng DT. Nightmare frequency in sexual assault survivors with PTSD. J Anxiety Disord. 2002b;16(2):175–90. doi:10.1016/S0887-6185(02)00093-2.
Kramer M, Kinney L. Sleep patterns in trauma victims with disturbed dreaming. Psychiatr J Univ Ott. 1988;13(1):12–6.
Lavie P. Sleep disturbances in the wake of traumatic events. N Engl J Med. 2001;345(25):1825–32.
Leskin GA, Woodward SH, Young HE, Sheikh JI. Effects of comorbid diagnoses on sleep disturbance in PTSD. J Psychiatr Res. 2002;36(6):449–52.
Levin R, Fireman G. Nightmare prevalence, nightmare distress, and self-reported psychological disturbance. Sleep. 2002;25(2):205–12.
Malcolm-Smith S, Solms M, Turnbull O, Tredoux C. Threat in dreams: an adaptation? Conscious Cogn. 2008;17(4):1281–91. doi:10.1016/j.concog.2007.07.002.
Malinowski J, Horton C. Evidence for the preferential incorporation of emotional waking-life experiences into dreams. Dreaming. 2014a;24(1):18.
Malinowski J, Horton C. Memory sources of dreams: the incorporation of autobiographical rather than episodic experiences. J Sleep Res. 2014b;23(4):441–7.
Mathes J, Schredl M. Analysis of a large sample of diary dreams – how typical are these typical dreams? Somnologie-Schlafforschung und Schlafmedizin. 2014;18(2):107–12.
Mellman TA, Kulick-Bell R, Ashlock LE, Nolan B. Sleep events among veterans with combat-related posttraumatic stress disorder. Am J Psychiatr. 1995;152(1):110–5.
Mellman TA, David D, Bustamante V, Torres J, Fins A. Dreams in the acute aftermath of trauma and their relationship to PTSD. J Trauma Stress. 2001;14(1):241–7. doi:10.1023/a:1007812321136.
Mellman TA, Bustamante V, Fins AI, Pigeon WR, Nolan B. REM sleep and the early development of posttraumatic stress disorder. Am J Psychiatr. 2002;159(10):1696–701.
Mellman TA, Knorr BR, Pigeon WR, Leiter J, Akay M. Heart rate variability during sleep and the early development of posttraumatic stress disorder. Biol Psychiatry. 2004;55(9):953–6.
Meyer EG, Schillerstrom JE. Prazosin for military combat-related PTSD nightmares: a critical review. J Neuropsychiatry Clin Neurosci. 2014;26(1):24–33.
Mysliwiec V, McGraw L, Pierce R, Smith P, Trapp B, Roth BJ. Sleep disorders and associated medical comorbidities in active duty military personnel. Sleep. 2013;36(2):167.
Nadorff MR, Fiske A, Sperry JA, Petts R, Gregg JJ. Insomnia symptoms, nightmares, and suicidal ideation in older adults. J Gerontol B Psychol Sci Soc Sci. 2013;68(2):145–52.
Nadorff MR, Lambdin KK, Germain A. Pharmacological and non-pharmacological treatments for nightmare disorder. Int Rev Psychiatry. 2014;26(2):225–36.
Phelps AJ, Forbes D, Creamer M. Understanding posttraumatic nightmares: an empirical and conceptual review. Clin Psychol Rev. 2008;28(2):338–55. doi:10.1016/j.cpr.2007.06.001.
Pigeon WR, Pinquart M, Conner K. Meta-analysis of sleep disturbance and suicidal thoughts and behaviors. J Clin Psychiatry. 2012;73(9):e1160–7.
Pigeon WR, Campbell CE, Possemato K, Ouimette P. Longitudinal relationships of insomnia, nightmares, and PTSD severity in recent combat veterans. J Psychosom Res. 2013;75(6):546–50.
Pillar G, Malhotra A, Lavie P. Post-traumatic stress disorder and sleep – what a nightmare! Sleep Med Rev. 2000;4(2):183–200.
Pineles SL, Mostoufi SM, Ready CB, Street AE, Griffin MG, Resick PA. Trauma reactivity, avoidant coping, and PTSD symptoms: a moderating relationship? J Abnorm Psychol. 2011;120(1):240–6.
Pruiksma K, Taylor D, Ruggero C, Boals A, Davis J, Cranston C, . . . Zayfert C. A psychometric study of the fear of sleep inventory-short form (FoSI-SF). J Clin Sleep Med. 2014;10(5):551–8.
Raskind MA, Peskind ER, Hoff DJ, Hart KL, Holmes HA, Warren D, . . . Gross C. A parallel group placebo controlled study of prazosin for trauma nightmares and sleep disturbance in combat veterans with post-traumatic stress disorder. Biol Psychiatry. 2007;61(8):928–34.
Revonsuo A. The reinterpretation of dreams: an evolutionary hypothesis of the function of dreaming. Behav Brain Sci. 2000;23(06):877–901.
Robert G, Zadra A. Measuring nightmare and bad dream frequency: impact of retrospective and prospective instruments. J Sleep Res. 2008;17(2):132–9.
Ross R, Ball W, Sullivan K, Caroff S. Sleep disturbance as the hallmark of posttraumatic stress disorder. Am J Psychiatr. 1989;146(6):697–707.
Schredl M. Effects of state and trait factors on nightmare frequency. Eur Arch Psychiatry Clin Neurosci. 2003;253(5):241–7.
Schreuder BJ, Kleijn WC, Rooijmans HG. Nocturnal re-experiencing more than forty years after war trauma. J Trauma Stress. 2000;13(3):453–63.
Sjöström N, Hetta J, Waern M. Persistent nightmares are associated with repeat suicide attempt: a prospective study. Psychiatry Res. 2009;170(2):208–11.
Spoormaker VI, Verbeek I, van den Bout J, Klip EC. Initial validation of the SLEEP-50 questionnaire. Behav Sleep Med. 2005;3(4):227–46.
Tanskanen A, Tuomilehto J, Viinamäki H, Vartiainen E, Lehtonen J, Puska P. Nightmares as predictors of suicide. Sleep. 2001;24(7):844–7.
Ulmer CS, Sutherland M, Edinger JD, Davidson J, Connor KM, Zhang W, Krystal A. REM sleep bout duration and frequency in PTSD. J Aggress Maltreat Trauma. 2012;21(1):67–76.
VA/DoD Clinical Practice Guideline. Management of post-traumatic stress. Washington, DC: VA Office of Quality and Performance, Version 2.0; 2010.
Valli K, Revonsuo A, Pälkäs O, Ismail KH, Ali KJ, Punamäki R-L. The threat simulation theory of the evolutionary function of dreaming: evidence from dreams of traumatized children. Conscious Cogn. 2005;14(1):188–218. doi:10.1016/S1053-8100(03)00019-9.
van Liempt S, van Zuiden M, Westenberg H, Super A, Vermetten E. Impact of impaired sleep on the development of PTSD symptoms in combat veterans: a prospective longitudinal cohort study. Depress Anxiety. 2013;30(5):469–74.
Walker MP. The role of sleep in cognition and emotion. Ann N Y Acad Sci. 2009;1156(1):168–97.
Wilmer HA. The healing nightmare: war dreams of Vietnam veterans trauma and dreams. Cambridge, MA: Harvard University Press; 1996. p. 85–99.
Wittmann L, Schredl M, Kramer M. Dreaming in posttraumatic stress disorder: a critical review of phenomenology, psychophysiology and treatment. Psychother Psychosom. 2006;76(1):25–39.
Zadra A. Recurrent dreams: their relation to life events trauma and dreams. Cambridge, MA: Harvard University Press; 1996. p. 231–47.
Zadra A, O’Brien SA, Donderi D. Dream content, dream recurrence and well-being: a replication with a younger sample. Imagin Cogn Personal. 1997;17(4):293–311.
Zadra A, Nielsen TA, Donderi D. Prevalence of auditory, olfactory, and gustatory experiences in home dreams. Percept Mot Skills. 1998;87(3):819–26.
Zadra A, Desjardins S, Marcotte E. Evolutionary function of dreams: a test of the threat simulation theory in recurrent dreams. Conscious Cogn. 2006;15(2):450–63.
Zayfert C, Deviva J, Pike J, Pigeon W. The role of fear of sleep in trauma-related insomnia. Sleep. 2005;28(S):A256.
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Pigeon, W.R., Carr, M. (2015). Nightmares and PTSD: Characterization, Theories, and Treatment Approaches. In: Martin, C., Preedy, V., Patel, V. (eds) Comprehensive Guide to Post-Traumatic Stress Disorder. Springer, Cham. https://doi.org/10.1007/978-3-319-08613-2_71-1
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